- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.28 / $203.07 / $286.50
| Professional | | $153.28 | $203.07 | $286.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.82 / $279.75 / $602.44
| Professional | | $165.82 | $279.75 | $602.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.08 / $293.44 / $358.19
| Professional | | $207.08 | $293.44 | $358.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.41 / $237.62 / $485.53
| Professional | | $159.41 | $237.62 | $485.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.81 / $293.77 / $671.39
| Professional | | $181.81 | $293.77 | $671.39 |